The  Registration  of  Vital 
Statistics  and  Good 
Business 


An  Address  Delivered  before  the  Annual  Conference  of 
Health  Officers  of  the  State  of  Indiana 
Indianapolis,  May  13,  1913 


BY 

LOUIS  I.  DUBLIN,  Ph.D.,  Statistician 


Metropolitan  Life  Insurance  Company,  New  York 
1913 


Digitized  by  the  Internet  Archive 
in  2017  with  funding  from 

University  of  Illinois  Urbana-Champaign  Alternates 


https://archive.org/details/registrationofvi00dubl_0 


/ m  13  s  c  3^® 


bit,  I 

H86 


THE  REGISTRATION  OF  VITAL  STATISTICS 
AND  GOOD  BUSINESS.* 


It  is  a  most  auspicious  occasion  that  brings  together  the  health 
officers  and  representative  business  and  professional  men  of  the 
State  of  Indiana  to  discuss  health  affairs.  The  subject  of  public 
health  is  no  longer  looked  upon  as  exclusively  within  the  province 
of  the  medical  profession.  This  is  a  promising  sign  of  the 
changing  attitude  of  communities  to  what  concerns  them  most 
vitally.  Progressive  health  officers  themselves  recognize  that 
their  work  is  communal  in  character  and  that  the  success  of  their 
endeavors  will  depend  largely  upon  the  co-operation  which  they 
receive  from  the  public  at  large,  and,  more  especially,  from  the 
leaders  of  public  opinion  who  determine  the  expenditure  of  public 
funds. 

The  medical  men  present  will  pardon  my  audacity  if  I  still 
further  indicate  that  the  intrusion  of  lay  minds  and  lay  points 
of  view  is  contributing  very  essential  stimuli  to  the  development 
of  modern  medicine.  The  contributions  of  the  engineer,  the 
educator,  the  statistician  and  the  statesman  to  the  field  of  pre¬ 
ventive  medicine  have  been  of  the  greatest  value.  They  have 
helped  to  extend  the  interest  of  medical  science  from  the  con¬ 
sideration  of  individual  cases  to  the  solution  of  broader  communal 
problems.  This  process  has,  indeed,  been  carried  to  such  a  point 
that  at  a  recent  discussion  by  health  officers  it  was  seriously 
urged  that  much  would  be  gained  in  the  advancement  of  public 
health  through  the  appointment  of  qualified  non-medical  officers 
for  the  enforcement  and  interpretation  of  sanitary  regulations. 
This  is  not  a  proper  occasion  for  the  discussion  of  this  question, 
but  I  refer  to  it  only  to  indicate  how  appropriate  it  is  for  those 
who  represent  the  other  professions  and  activities  in  your  com¬ 
munities  to  get  together  with  the  health  authorities  to-night  to 
consider  with  them  the  many  matters  that  vitally  concern  you. 

*An  address  delivered  at  the  public  meeting  of  the  Annual  Conference  of  Health  Officers  of 
the  State  of  Indiana,  Indianapolis,  May  13.  1913. 


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The  subject  which  your  able  State  Secretary,  Dr.  Hurty,  has 
suggested  for  my  paper  is  “The  Registration  of  Vital  Statistics 
and  Good  Business.”  In  the  very  title  there  is  the  implication 
that  this  phase  of  health  administration  is  closely  related  to  busi¬ 
ness  affairs  and  can  be  tested  by  the  same  standards  that  are  used 
daily  to  determine  the  value  or  lack  of  value  of  other  industrial 
activities. 

Statistics,  in  brief,  is  a  system  of  accounting.  The  executive 
in  industry  and  finance  requires  for  the  efficient  administration 
of  his  business  detailed  analyses  of  the  cost  of  production  and 
distribution.  Aside  from  the  assistance  which  such  statistics 
give  him  in  the  determination  of  a  selling  price  for  the  product,  they 
furnish  him  above  all  with  a  convenient  method  for  checking 
the  efficiency  of  his  plant  management.  Cost  accounting  requires 
that  each  unit  of  raw  material  shall  be  traced  through  the  factory 
in  such  manner  that  the  value  which  every  process  adds  to 
it  is  recorded.  Through  these  accounts,  the  executive  learns 
whether  it  is  profitable  to  substitute  machines  for  hand  labor. 
He  is  also  enabled  to  detect  ill-advised  applications  of  labor 
and  wastefulness  in  the  manipulation  of  materials.  Such  evils, 
unless  immediately  discovered,  lead  to  inefficiency  and  the  sub¬ 
sequent  disorganization  of  an  otherwise  well-conducted  enterprise. 

The  health  officer  of  the  community  has  a  problem  similar 
to  that  of  the  business  manager  in  industry.  He,  too,  must  test 
the  efficiency  of  his  management.  His  raw  materials  are  the 
human  beings  of  his  district.  He  must  be  able  to  trace  the  path 
of  these  individuals  through  life,  from  the  date  of  their  birth, 
through  the  years  of  their  childhood  to  their  maturity  and  marriage, 
until  finally  death  terminates  their  record  in  the  community’s 
book  of  accounts.  He  must  check  up  his  methods  of  procedure 
in  combating  disease  and  must  be  in  a  position  to  determine 
whether  the  forces  which  he  has  applied  are  productive  of  results. 
He  also  should  be  immediately  apprised  of  any  new  perils  to  the 
public  health  which  may  arise.  If  his  administration  is  one  of 
mere  routine,  handling  details  only,  without  inspiration  and  the 
force  of  directive  ideas,  then  his  community  is  on  the  road  to 
civic  inefficiency  with  all  the  disorganization  that  this  implies. 

It  is  the  function  of  the  vital  statistician  to  provide  the  neces¬ 
sary  data  to  the  health  officer  for  the  settlement  of  these  questions. 
He  must  know  from  year  to  year  the  composition  and  characteris¬ 
tics  of  the  population.  He  must  also  have  available  an  accurate 


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record  of  the  number  of  additions  to  the  population  by  births  and 
immigration,  and  of  the  number  of  deaths,  marriages  and  divorces. 
Finally,  he  must  know  the  number,  location  and  intensity  of 
the  incidences  of  transmissible  disease.  Such,  in  brief,  is  the  sub¬ 
ject  matter  of  vital  statistics. 

Let  us  now  consider  the  intimate  aspects  of  each  of  these 
subordinate  fields  of  vital  statistics. 

Composition  and  Characteristics  of  the  Population. 

Knowledge  of  the  composition  and  characteristics  of  the 
population  is  fundamental  for  the  vital  statistician.  It  is  to 
him  what  an  inventory  is  to  the  industrial  engineer.  He  must 
have  at  his  disposal  an  enumeration  by  age,  sex,  race,  nationality 
and  marital  condition  and  by  such  other  characteristics  as  are 
indicated  by  the  peculiar  conditions  prevailing  in  his  community. 
The  age  distribution,  for  example,  is  vital  to  any  intelligent 
consideration  of  the  death  rate.  Newer  communities  where  the 
proportion  of  infants  is  small  often  show  a  lower  death  rate  than 
others  with  better  health  standards  where  the  distribution  of  the 
component  parts  is  more  nearly  normal.  The  distribution  by 
sex  is  indicative  of  the  extent  to  which  a  community  is  settled 
in  its  social  and  moral  standards.  Recently  settled  communities 
show  a  marked  excess  of  males ;  it  is  only  when  the  female  element 
has  attained  its  normal  proportion  that  there  come  into  evi¬ 
dence  those  characteristics  of  social  and  moral  stability  which  are 
attributes  of  modern  civilization.  The  race  factor  is  important  in 
determining  the  educational  program  of  a  community  as  well  as 
in  testing  the  prevailing  mortality  conditions.  The  nationalities 
composing  a  community  outline  the  problem  confronting  social 
and  philanthropic  agencies  whose  work  it  is  to  help  assimilate  the 
alien  and  to  adjust  his  condition  harmoniously  to  the  rest  of  the 
community.  Information  of  this  character,  renewed  every  five 
years,  should  be  of  incalculable  value  in  determining  conditions  of 
community  life,  and  should  serve  as  an  index  of  progress  or 
retrogression. 

Births. 

Births  are  the  primary  items  of  population  income.  They 
are  interesting  as  to  their  actual  number,  an  excess  of  births  over 
deaths  constituting  the  natural  increment  of  population.  From 
the  number  of  births  we  derive  birth  rates,  or  the  ratio  between 

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the  number  of  births  and  the  number  of  persons  living.  Nothing 
reflects  better  the  vitality  of  a  community  than  its  birth  rate. 
The  associated  factors  of  legitimacy,  nationality  and  social  position 
of  parents  throw  light  on  the  problem  of  national  fecundity  and 
indicate  from  which  sources  our  population  is  being  derived. 

No  phase  of  social  hygiene  has  recently  received  more  attention 
than  the  conservation  of  infant  life.  The  movement  has  received 
great  impetus  since  the  establishment  of  the  Children’s  Bureau 
in  Washington  under  the  direction  of  Miss  Julia  C.  Lathrop. 
This  organization  has  defined  its  first  problem  to  be  the  determina¬ 
tion  of  the  birth  and  death  rates  of  infants,  but  in  this  work  it  is 
hampered  by  the  fact  that  in  only  eight  States  of  the  country 
are  records  kept  with  sufficient  accuracy  to  justify  any  conclusions. 
Thousands  of  children  are  born  annually  in  our  country  and  are 
neither  recorded  at  the  time  of  their  birth  nor  at  their  death, 
which  in  more  than  one-fifth  of  the  cases  occurs  during  their 
first  year  of  life. 

Legal  considerations  of  the  highest  importance  enter  into 
the  registration  of  births.  Communities  are  waking  up  to  their 
obligations  to  restrict  child  labor.  Without  adequate  regis¬ 
tration  of  births  such  regulation  is  hampered  and  the  law  often 
nullified  in  its  effect.  In  this  way,  many  children  are  deprived  of 
education  and  are  permitted  to  waste  their  limited  energies  in 
industrial  pursuits,  later  to  become  the  subjects  of  community 
relief.  The  transactions  of  life  insurance  companies  frequently 
call  for  the  legal  proof  of  true  age.  Since  the  differences  in  pre¬ 
mium  charges  vary  with  the  age,  it  will  be  seen  that  the  factor 
of  age  is  essential  to  the  determination  of  the  amount  of  benefit 
which  is  to  be  paid  at  death.  A  case  in  point  from  the  experience 
of  the  Metropolitan  Life  will  be  of  interest.  There  is  now  in  suit 
a  case  where  the  insured’s  age,  according  to  the  policy,  was  fifty 
years  at  the  time  of  death;  according  to  the  health  department 
register,  the  true  age  at  death  was  seventy-two.  In  this  case, 
if  the  transcript  of  the  birth  certificate  could  have  been  secured, 
it  would  very  quickly  have  settled  the  question  as  to  the  true 
age  at  death.  The  insured  was  born  in  a  foreign  country,  however, 
which  had  no  better  facilities  for  the  registration  of  births  than 
many  States  in  our  Union  now  have. 

A  case  nearer  home  will  also  be  of  interest.  A  boy  of  thirteen, 
residing  in  Indiana,  was  insured  with  us  in  1904  under  one  name, 
and  his  mother  was  designated  as  beneficiary  under  the  policy.  In 


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March,  1913,  he  advised  us  that  he  had  been  insured  under  a 
wrong  name,  and  that  the  relationship  of  the  beneficiary  as  given 
was  incorrect.  In  proof  of  the  contention  made  we  desired  a 
certified  copy  of  the  birth  record  of  the  boy  to  establish  his 
identity,  but  we  were  informed  that  no  official  birth  record  could 
be  obtained,  although  the  names  in  the  case  represented  old  and 
well-known  families  in  the  county.  It  would  appear,  therefore, 
that  in  this  State  the  records  of  births  were  not  kept  with  any 
degree  of  accuracy  as  recently  as  the  year  1892.  Some  countries 
are  more  fortunate.  Great  Britain,  Germany,  France,  Italy  and 
Sweden  have  had  a  compulsory  system  of  birth  registration  for 
many  years.  From  these  countries  records  of  birth  are  obtained 
with  the  least  expenditure  of  time  and  effort. 

The  establishment  of  personal  identity  often  depends  upon 
the  validity  of  a  birth  record.  Litigation  in  matters  of  property 
inheritance,  the  settlement  of  estates  and  the  disposition  of  trusts, 
can  in  many  instances  be  avoided  when  accurate  birth  records  are 
at  hand.  Special  problems  in  the  morbid  aspects  of  social  life,  such 
as  the  age  of  consent,  the  gravity  of  the  offense  in  criminal  cases, 
etc.,  depend  upon  efficient  birth  registration.  Nor  can  we  say 
just  what  social  readjustments  are  necessary  in  dealing  with  the 
acute  problem  of  illegitimacy,  because  we  lack  utterly  information 
upon  wThich  to  base  an  intelligent  analysis  of  the  situation. 

Marriages. 

The  statistics  of  marriage  are  in  close  connection  with  birth 
statistics.  Data  of  this  nature  are  of  value  to  investigators  of 
community  welfare.  The  marriage  rate  is  in  the  nature  of  a 
barometer  of  a  nation’s  prosperity.  In  countries  where  accurate 
marriage  statistics  have  been  kept  the  records  show  that  periods 
of  commercial  prosperity  have  been  marked  with  consistently  high 
marriage  rates,  and  those  of  depression  with  low  rates.  The 
physical  and  mental  condition  of  the  parties  to  marriages  is  also 
of  vital  importance  to  the  State  and  should  be  made  a  matter 
of  record.  Evidences  are  already  at  hand  that  many  of  our 
social  and  even  economic  problems  are  caused  by  the  mating  of 
inferior  stock.  Alcoholics,  the  shiftless,  imbeciles  and  criminals 
are  permitted,  through  marriage,  to  aggravate  our  social  problems 
by  indiscriminate  breeding  and  thereby  perpetuate  their  like  to 
act  as  even  heavier  burdens  on  future  generations.  In  this  coun¬ 
try  the  students  of  eugenics  have  no  accurate  data  to  guide 

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r  «> 

* 

them  in  their  endeavors  for  the  improvement  of  our  national 
race  stock.  Our  neglect  to  provide  intelligible  birth  and  mar¬ 
riage  statistics  is  a  source  of  grave  social  loss,  and  I  cannot 
urge  too  strongly  your  active  participation  in  all  efforts  which 
will  improve  our  statistics  of  these  social  facts. 

The  legal  aspects  of  marriage  registration  are  strikingly  brought 
home  to  us  in  the  life  insurance  business.  Life  insurance  com¬ 
panies  and  other  organizations  administering  trust  funds  are 
constantly  involved  in  expensive  litigation  to  establish  the  validity 
of  claims  arising  out  of  defective  or  non-existent  records  of  mar¬ 
riage.  Questions  sometimes  arise  as  to  the  identity  of  wives 
named  as  beneficiaries  in  policy  contracts.  A  typical  case  from 
our  own  experience  will  interest  you.  An  unmarried  lady  was 
named  in  a  policy  of  $10,000  as  the  beneficiary.  After  her  sub¬ 
sequent  marriage,  she  requested  the  Company  to  change  the  name 
entered  upon  the  policy  to  the  one  she  assumed  at  marriage. 

As  is  our  uniform  practice  in  such  cases,  we  requested  a  certified 
copy  of  the  marriage  certificate,  in  order  to  protect  the  interests 
of  all  parties  to  the  contract  and  avoid  future  litigation.  Unfor¬ 
tunately,  no  certified  record  was  obtainable,  and  we  were  obliged, 
with  reluctance,  to  accept  an  affidavit  from  the  parties  concerned. 

These  are  possible  sources  of  litigation.  Other  instances  occur 
where  more  than  one  claimant  appears  as  the  beneficiary  under 
the  contract,  each  claiming  to  be  the  wife  of  the  deceased.  In 
such  cases,  a  marriage  certificate  is  necessary  to  establish  the 
truth,  in  order  that  the  Company  may  proceed  to  settle  its  obli¬ 
gations.  The  lack  of  these  fundamental  documents  in  civic 
accounting  leads  invariably  to  confusion  and  economic  loss  which, 
in  the  last  analysis,  is  borne  by  the  community  at  large. 

Deaths. 

We  can  consider  as  our  fourth  point  of  investigation  into  the 
subject  matter  of  vital  statistics,  the  significance  of  death  regis¬ 
tration.  A  death  constitutes  a  loss  to  the  community  especially 
when  young  lives,  full  of  promise  and  potential  usefulness,  are 
terminated.  It  is  obvious  that  in  community  management  the 
losses  should  be  closely  analyzed  as  to  age,  cause  of  death,  economic 
and  social  condition  of  the  deceased,  etc.,  to  indicate  the  precise 
lines  of  endeavor  which  the  health  officer  and  other  officials  should 
institute  for  the  prevention  of  similar  losses.  This  surely  would 

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be  the  procedure  in  the  conduct  of  private  business,  and  there  is 
no  reason  why  community  losses  should  not  be  subject  to  the 
same  scrutiny. 

The  complete  registration  of  deaths  makes  possible  the  calcula¬ 
tion  of  a  death  rate.  Death  rates,  however,  require  a  supplementary 
analysis  before  community  wastes  can  be  traced  to  their  sources. 
The  first  step  in  the  analysis  is  the  calculation  of  the  rates  by 
ages,  for,  as  you  well  know,  the  age  constitution  of  a  population 
is  an  important  factor  in  determining  its  total  mortality.  With 
this  fuller  knowledge,  the  authorities  can  make  a  comparison  with 
the  experience  of  other  communities  to  ascertain  whether  their 
losses  are  abnormal  at  any  particular  age.  It  is  a  common 
occurrence  for  communities  with  normal  general  death  rates  to 
suffer  excessively  at  certain  ages.  Such  facts  can  then  be 
brought  to  the  attention  of  responsible  officials  and  their  energies 
directed  to  specific  remedial  measures. 

The  utility  of  accurate  mortality  statistics  by  ages  has  never 
before  been  demonstrated  with  such  emphasis  as  in  the  movement 
for  the  conservation  of  infant  life.  Agencies  for  education  and 
practical  social  work,  such  as  nursing  associations,  diet  kitchens, 
milk  stations  and  others,  are  concentrating  their  energies  upon 
the  solution  of  this  problem  which  is  of  such  intimate  concern 
to  society  at  large.  The  work  of  these  institutions  for  preventing 
infant  mortality  is  directed  at  improved  sanitation,  better  housing, 
and  the  education  of  mothers  in  the  care  of  infants,  and  their 
efforts  depend  wholly  upon  the  prior  and  exhaustive  knowledge 
which  good  statistics  alone  can  develop. 

Again,  the  incidences  of  sex,  nationality  and  occupation  have 
their  effect  in  coloring  death  rates  of  communities.  A  super¬ 
abundance  of  deaths  in  a  certain  occupation-group  indicates  the 
presence  of  adverse  industrial  conditions  and  points  out  the 
need  for  the  enforcement  of  the  labor  laws  or  the  necessity  for 
more  stringent  legislation.  The  ultimate  effect  of  occupation  upon 
the  health  of  women  in  industry  is,  moreover,  made  evident  by 
a  minute  study  of  mortality  data  from  the  standpoint  of  occupation 
and  sex.  The  tabulation  of  deaths  and  death  rates  by  locality 
is  also  of  use  in  discovering  whether  the  application  of  special 
neighborhood  health  work  is  necessary.  When  one  section  of  a 
city  contributes  more  than  its  share  of  typhoid  deaths,  it  is  certain 
that  local  sanitary  conditions  need  supervision  and  correction. 
By  inaugurating  proper  measures,  the  causes  may  often  be  removed 


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and  the  disease  prevented  from  extending  its  ravages  to  other 
parts  of  the  city. 

You  will  now  readily  see  the  importance  of  recording  full  and 
accurate  statements  of  the  essential  particulars  regarding  deaths. 
Items  of  name,  age,  place  of  death,  date  of  death,  marital 
condition,  parentage  and  an  accurate  statement  of  all  the  morbid 
conditions  which  have  had  any  bearing  upon  the  death,  should 
receive  the  utmost  attention  from  health  officers.  No  part  of  a 
death  certificate  should  be  admitted  to  the  official  files  of  the 
health  offices  until  every  error  of  fact  is  adjusted.  Some  State 
laws,  fortunately,  require  registration  officials  to  demand  defin¬ 
ite  information  from  physicians,  coroners  and  midwives  who  fill  out 
such  certificates,  whenever  data  are  missing,  inaccurate,  indefinite 
or  incomplete.  In  other  States,  and  they  are  the  larger  number, 
the  registration  laws  are  of  indefinite  force-,  and  the  returns  reflect 
this  condition.  Only  a  stern  and  unrelenting  criticism  of  docu¬ 
ments  can  make  statistics  of  this  character  reliable. 

The  accurate  statement  of  the  cause  of  death  is,  of  all  the  items 
in  the  death  certificate,  the  most  important,  and  at  the  same  time 
it  involves  the  greatest  difficulty  in  tabulation.  In  order  that  the 
utmost  practical  value  may  be  obtained  from  the  returns,  it  is 
necessary  to  adopt  a  uniform  system  of  classification  which  will 
permit  the  comparison  of  mortality  statistics  of  different  communi¬ 
ties.  The  requirement  for  international  comparability  is  admir¬ 
ably  met  by  the  Bertillon  Classification,  now  in  use  by  the  leading 
registration  offices  throughout  the  world.  This  International 
List,  as  you  know,  comprises  189  standard  titles  which  are  grouped 
under  14  general  headings.  Each  standard  title  in  the  list 
includes  under  it  the  names  of  the  diseases  or  conditions  which 
can  properly  be  classified  with  it.  Thus,  under  “Typhoid  Fever” 
we  find  such  synonyms  as  “Continued  Fever,”  “Enteric  Fever,” 
etc.  Registration  officials  who  in  their  practice  meet  with  these 
rarer  terms  on  death  certificates,  therefore,  classify  such  returns 
uniformly  under  the  “Typhoid  Fever”  title.  It  will  readily  be 
seen  that  uniformity  of  this  character  is  absolutely  essential  to 
the  comparability  of  typhoid  fever  rates,  especially  since  various 
designations  are  still  extensively  employed  in  different  sections 
of  the  country  to  describe  the  same  morbid  conditions.  Other 
titles  present  similar  problems  of  classification  which  are  solved 
by  the  use  of  the  International  List.  To  this  end,  I  most  earnestly 
recommend  the  close  study  of  the  Bertillon  system  of  classification 


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by  health  officers,  and  especially  of  its  discussion  of  the  technique 
of  classification  for  “multiple”  causes  of  death. 

Returns  of  Cause  of  Death  should  include  all  the  morbid  con¬ 
ditions  contributing  to  the  death,  together  with  a  statement  of 
the  duration  of  the  disease  and  of  its  complications.  It  is  especially 
important  that  the  terms  employed  shall  be  of  the  standard 
nomenclature  of  the  International  Classification.  The  designation 
of  terminal  conditions,  such  as  “peritonitis,”  “acute  nephritis,” 
“paralysis,”  “dropsy”  and  “meningitis,”  and  of  such  vague 
returns  as  “marasmus,”  “heart  failure,”  “hemorrhage,”  “con¬ 
vulsions”  and  “fractures,”  are  wholly  undesirable,  and  should 
be  sharply  questioned  by  health  officers  for  more  definite  informa¬ 
tion  which  will  permit  of  intelligent  tabulation  of  the  data.  Nearly 
eight  per  cent,  of  the  death  certificates  which  enter  the  statistical 
laboratory  of  the  Metropolitan  Life  Insurance  Company  present 
Cause  of  Death  returns  which  require  further  information  to 
permit  of  accurate  tabulation.  It  is  our  practice  to  address  a  letter 
of  inquiry  to  the  physician  or  coroner  signing  the  certificate  in 
each  case  for  more  definite  data,  and  it  is  gratifying  to  observe 
that  in  the  large  number  of  cases,  clarifying  replies  are  received  in 
place  of  the  earlier  indefinite  and  unsatisfactory  returns.  Thus, 
in  twenty-six  returns  of  peritonitis  without  qualification,  inquiry 
revealed  that  three  deaths  were  caused  by  self-induced  abortion, 
two  by  criminal  abortion,  two  by  appendicitis,  three  by  puerperal 
fever,  one  by  gonococcus  infection,  and  the  rest  by  causes  such  as 
alcoholism,  tuberculosis,  traumatism  by  falling,  typhoid  fever 
and  cancer.  Not  one  of  the  twenty-six  cases  was  ultimately 
classified  as  “peritonitis.” 

These  facts  are  reflected  in  Chart  I,  which  shows  the 
successive  annual  death  rate  from  such  indefinite  causes  as  “peri¬ 
tonitis”  and  “dropsy”  for  the  years  1900  to  1911  inclusive.  You 
will  see  that  the  number  of  cases  under  these  two  titles  have 
regularly  decreased  in  frequency.  This  is  undoubtedly  the  result 
of  the  more  rigid  requirements  of  the  Census  Bureau,  which  con¬ 
sistently  returns  such  an  assignment  of  the  cause  of  death  to  the 
certifying  physician  for  a  more  definite  statement  of  the  cause. 


ll 


16 


15.1 

Apparent  Decreases  in  “Peritonitis 
Death  Rates — Registration  Are 

”  and 

a — 19C 

“Drop 

)0-191] 

>sy” 

L 

13.0 

1  .9 

^02 

1  0.0^ 

o 

© 

o' 

o 

H 

u 

Periton 

litis  ”\ 

s9.1 _ 

Vh 

<L> 

a, 

a> 

8.0 

W 

>7.2 

7.3 

K 

6.4- 

\ 

6.0 

5.0 

,5.1 

4.5 

3/7 

,3.4 

2  9 

4.0 

“Di 

•opsy  ” 

2.6 

2.2 

4.8 

1 .4 

Ti 

Discor 

tie 

itinued 

2 

1 

0 

1900  1901  1902  1903  1904  1905  1906  1907  1908  1909  1910  1911 

CHART  I 


# 

18 

17 

16 

15 

14 

13 

12 

11 

10 

9 

8 

7 

6 

5 

4 

3 

2 

1 

0 


1901  1902  1903  1904  1905  1906  1907  1908  1909  1910  1911 


CHART  II 


K 


The  term  “poisoning”  without  further  definition  is  often 
converted  upon  inquiry  to  a  statement  of  “suicide,”  as  have  also 
numerous  instances  of  so-called  ‘  ‘  drowning.  ”  “  Gunshot  wounds  ’ ’ 

turn  out  to  be  clear  cases  of  “homicide,”  while  “fractures,”  upon 
further  investigation,  are  found  to  be  masked  cases  of  railroad,  auto¬ 
mobile  and  machinery  accidents.  It  is  not  surprising,  therefore,  to 
find,  as  is  shown  in  Chart  II,  that  the  rates  for  “homicide”  and 
“suicide”  have  increased  regularly  during  the  period  since  the 
inauguration  of  more  scientific  compiling  methods.  In  the  light  of 
this  fact,  it  is  difficult  to  determine  whether  the  indicated  increases 
really  represent  a  greater  incidence  of  homicide  and  suicide  in 
the  Registration  Area,  or  rather  the  effect  of  more  efficient 
statistical  methods. 

Inquiries  into  returns  of  “meningitis”  develop  the  existence 
of  the  acute  infectious  diseases  such  as  “scarlet  fever,”  “diph¬ 
theria,”  “measles”  and  “whooping-cough.”  The  return  “pneu¬ 
monia,”  in  like  manner,  is  a  mask  for  a  whole  host  of  more  definite 
conditions  such  as  “measles,”  “scarlet  fever,”  “traumatisms” 
and  “alcoholism.”  In  view  of  the  special  interest  of  the  com¬ 
munity  in  these  conditions,  it  is  extremely  important  that  there 
shall  be  especially  complete  registration  of  the  cases  in  which 
the  communicable  diseases  are  the  determining  causes.  It  is 
reprehensible  enough  when  the  substitution  of  a  terminal  condition 
for  a  primary  cause  leads  to  the  over-registration  of  undesirable 
titles,  but  what  is  more  serious,  is,  that  in  this  way,  fatal  cases  of 
infectious  and  contagious  diseases  or  of  industrial  and  general 
violence  are  left  unrecorded. 

Sickness. 

Finally,  the  statistics  of  sickness  are  materials  for  the  vital 
statistician.  The  subject  is,  however,  of  such  vast  import  that 
it  will  be  impossible  to  refer  to  it  in  this  address  beyond  the  state¬ 
ment  that  it  is  through  the  analysis  of  case  records  of  illness 
that  much  light  is  thrown  upon  the  causal  phases  of  disease  and 
also  upon  clinical  treatment.  Statistics  are,  moreover,  the 
chief  test  at  the  disposal  of  the  community  of  its  effective  control 
over  transmissible  disease.  To-day,  millions  of  dollars  are  being 
expended  annually  by  communities  in  their  campaigns  against 
tuberculosis  and  other  disorders,  with  the  hope  that  the  various 
activities  may  check  disease  at  one  point  or  another.  It  is  for  a 
statistical  investigation  to  determine  the  degree  to  which  these 


14 


t 


efforts  have  been  productive  of  results.  Thus  will  be  decided  the 
fate  of  such  experiments  as  visiting  nursing,  disinfection,  isolation, 
sanatorium  treatment  for  incipient  tuberculosis  and  other  ventures 
still  under  judgment. 

In  concluding  this  discussion  of  the  business  value  of  regis¬ 
tration,  I  hope  that  I  have  indicated  the  extent  and  character  of 
the  losses  which  result  from  neglect  of  thoroughly  registering  vital 
phenomena.  If  communities  were  to  realize  that  they  are  called 
upon  ultimately  to  meet  these  losses,  I  think  that  we  would  have 
an  awakening  of  public  interest  in  careful  civic  accounting  of 
human  life.  A  wide-awake  development  in  this  direction  would 
favorably  affect  the  transaction  of  business  along  many  lines. 
In  life  insurance  companies  alone,  fully  one-quarter  of  the  disputes 
would  never  arise  were  adequate  records  at  hand.  The  saving 
of  losses  due  to  present  litigation  could  then  be  returned  as  larger 
benefits  to  our  clients,  and  would  remove  many  causes  for  dis¬ 
satisfaction.  We  cannot  regard  these  losses  as  anything  more 
than  downright  waste. 

The  solution  of  the  problems  is  entirely  in  your  hands.  Surely 
you  must  see  that  it  is  good  business  for  a  community  to  take 
these  necessary  precautions  to  account  for  its  most  vital  resources. 
Nothing  less  than  a  most  efficient  system  of  accounting  is  now 
tolerated  in  any  line  of  modern  business,  and  surely  the  most 
important  business,  that  which  is  concerned  with  the  physical 
welfare  of  us  all,  should  not  be  satisfied  with  anything  less. 


15 


T 


t 


STANDARD  CERTIFICATES  OF  BIRTH  AND  DEATH. 


»  O 

a 

O  H  5 

I  0  u  * 

!  z  - 1 

s  7  *  ^ 

£  z  U  « | 

0  -  CL  b  q 

“  c  £  5! 
lo2  ; 
|  n  *r  si 

§  S  *  § ! 

i  *  s  a 

o.  U  =  S« 

s  ffl  S  8^ 

£  ui  £  *  t 

S  n  5  si 
|  z  5  !| 
joi  ^ 
I  <  S'  I 

8  s  £  i 

s  a* 

I  t  8 

|  S  2 
§  1 
1IJ  - 


PLACE  OF  BIRTH 

County  of - 

Township  of _ 

Village  of - _ - 

City  of -  (No. 

FULL  NAME  OF  CHILD  . . . . . 


Brpartmrut  uf  Cnmmrrrr  anil  *~*hrw- 

BUREAU  OF  THE  CENSUS 

STANDARD  CERTIFICATE  OF  BIRTH 


Registered 


Twin,  trlpM, 
or  other  7 

(To  be  answered  only  Ii 


Number  In  order 
of  birth 

event  of  plural  blithe) 


BIRTHPLACE 


OCCUPATION 


Number  of  children  born  t 


i  mother,  including  present  b 


FULL 

MAIDEN 

NAME 


BIRTHPLACE 


OCCUPATION 


Number  of  children  of  this  mother  r 


v  living  . 


I  hereby  certify  that  I  attended  the  birth  of  this  child,  who 
on  the  date  above  stated. 


[  *  When  there  tea*  no  attending  physician 
]  or  midwife,  then  the  father .  householder, 
j  etc.,  should  make  this  return .  A  stillborn 
I  child  is  one  that  neither  breathes  nor  shows 
l  other  evidence  of  life  after  birth. 


Given  name  added  from  a  supplemental  Address- 
report - .,19 


CERTIFICATE  OF  ATTENDING  PHYSICIAN  OR  MIDWIFE* 

(BorifiHVVorBSUbom) 

(Signature) _ 

(Physician  or  Midwife) 


REGISTRAR 


A 


Good  vital  statistics  depend  upon  these  certificates. 
Do  you  use  them  in  your  State  ? 


f 


